Sertraline as Monotherapy in the Treatment of Psychotic and Nonpsychotic Depression

Simpson, George M.; Sheshai, Adel El; Rady, Ahmed; Kingsbury, Steven J.; Fayek, Mohamed

doi:10.4088/jcp.v64n0817

Cited by 22 publications

(16 citation statements)

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“…Younger adults gained significantly more weight than older subjects (mean [SD], 6.5 [6.6] kg vs 3.3 [4.9] kg, P = .001). Although the STOP-PD study did not include a sertraline monotherapy arm, a previous open-label study 50 reported that patients with major depression with psychotic features had a markedly lower response rate to 200 mg of sertraline per day for 8 weeks than patients with nonpsychotic depression.…”

Section: Newer Medicationsmentioning

confidence: 99%

Challenges in the Treatment of Major Depressive Disorder With Psychotic Features

Rothschild¹

2013

Schizophrenia Bulletin

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Psychotic depression is associated with significant morbidity and mortality but is underdiagnosed and undertreated. In recent years, there have been several studies that have increased our knowledge regarding the optimal treatment of patients with psychotic depression. The combination of an antidepressant and antipsychotic is significantly more effective than either antidepressant monotherapy or antipsychotic monotherapy for the acute treatment of psychotic depression. Most treatment guidelines recommend either the combination of an antidepressant with an antipsychotic or ECT for the treatment of an acute episode of unipolar psychotic depression. The optimal maintenance treatment after a person responds to either the antidepressant/antipsychotic combination or the ECT is unclear particularly as it pertains to length of time the patient needs to take the antipsychotic medication. Little is known regarding the optimal treatment of a patient with bipolar disorder who has an episode of psychotic depression or the clinical characteristics of responders to medication treatments vs ECT treatments.

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Section: Newer Medicationsmentioning

confidence: 99%

Challenges in the Treatment of Major Depressive Disorder With Psychotic Features

Rothschild¹

2013

Schizophrenia Bulletin

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“…Methodological limitations in the trial design65 and a separate report that patients with MDpsy had a markedly lower response rate to 200 mg/day of sertraline than patients with nonpsychotic depression66, highlight the need for additional trials to compare the efficacy of antidepressant monotherapy to combination treatment.…”

Section: Commentmentioning

confidence: 99%

A Double-blind Randomized Controlled Trial of Olanzapine Plus Sertraline vs Olanzapine Plus Placebo for Psychotic Depression

Meyers

Flint

Rothschild

et al. 2009

Arch Gen Psychiatry

211

130

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Context: Expert guidelines recommend that the pharmacological treatment of major depression with psychotic features (MDpsy) combines antidepressant with antipsychotic medications. However, evidence for the efficacy of combination pharmacotherapy has been limited and without positive trials in geriatric patients. Objective: (1) Compare remission rates in MDpsy associated with combination atypical antipsychotic medication plus a serotonin-reuptake-inhibitor antidepressant (SSRI) to remission associated with antipsychotic monotherapy; (2) Compare the efficacy and tolerability of treatment in younger versus older adults. Design and Context: Twelve-week double-blind randomized controlled comparison of olanzapine plus sertraline to olanzapine plus placebo conducted on clinical services of four academic sites. Patients and Interventions: 259 subjects with MDpsy randomized by age ≥60 on a 1:1 basis; mean age of 117 younger adults = 41.3(10.8) versus 71.7(7.8) in 142 geriatric participants; target doses of olanzapine 15-20 mg/day plus masked sertraline or placebo at 150-200 mg/day. Results: Olanzapine/sertraline was associated with a higher remission rates over the trial than olanzapine/placebo (OR=1.28, 95% CI =1.12-1.47, p<.001). 41.9% of combination subjects were in remission at their last assessment compared to 23.9% of olanzapine monotherapy subjects (χ21= 9.53, p=.002). Combination therapy was comparably superior in younger adult (OR=1.25, 95% CI =1.05-1.50, p=.02) and older subjects (OR=1.34, 95% CI =1.09-1.66, p=0.01). Secondary efficacy measures also supported combination treatment. Overall tolerability was comparable across age groups, with age-related differences in specific side effects. Both age groups had significant increases in cholesterol and triglyceride levels, but statistically significant increases in glucose occurred only in younger adults (t=2.76, df=205, p=.01). Although both age groups experienced significant weight gain, younger adults gained significantly more weight (14.5±14.7 versus 7.3±10.9 pounds, F=11.10, df=1,221, p=.001). Conclusions: Combination pharmacotherapy is efficacious for the treatment of MDpsy. Future research must determine the benefits of continuing atypical antipsychotic medications beyond twelve weeks against the associated metabolic effects. Trial Registration and URL: Clinicaltrials.gov Registry ID: NCT00056472

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“…(de Kloet et al, 1998) This finding has lead to a series of studies assessing the efficacy and safety of mifepristone (RU486) in the treatment of PMD. Early studies by Belanoff et al, (2001Belanoff et al, ( , 2002 and Simpson et al, (2003) (Figure 8) demonstrated improvement in both depression and psychosis in a dose dependent manner. (2009), in a multi-site study (n=29), 56 day, placebo controlled study, demonstrated a rapid reduction in the Brief Psychiatric Rating Scale-Positive Symptoms Subscale (BPRS-PSS) in only 7 days with mifepristone compared to placebo; response rates were defined as a 50% reduction in BPRS-PSS from baseline at both days 7 and 56.…”

Section: Treatment Straegies For Pmdmentioning

confidence: 99%

“…( Rothschild & Phillips, 1999) In addition, there has been no replication of these results. In an 8-week open study comparing the efficacy of sertraline monotherapy in PMD (n=25) versus NPMD (n=25)), Simpson et al, (2003) found remission rates of 16% and 64% in patients with PMD and NPMD respectively (p=.001).…”

Section: Treatment Straegies For Pmdmentioning

confidence: 99%

An Update on Psychotic Depression

Matthews¹

2012

Mental Illnesses - Understanding, Prediction and Control

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Sertraline as Monotherapy in the Treatment of Psychotic and Nonpsychotic Depression

Cited by 22 publications

References 0 publications

Challenges in the Treatment of Major Depressive Disorder With Psychotic Features

Challenges in the Treatment of Major Depressive Disorder With Psychotic Features

A Double-blind Randomized Controlled Trial of Olanzapine Plus Sertraline vs Olanzapine Plus Placebo for Psychotic Depression

An Update on Psychotic Depression

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